Hypothyroidism
Introduction
Introduction to hypothyroidism Hypothyroidism (referred to as hypothyroidism) is a disease in which the body's metabolism is reduced due to reduced synthesis and secretion of thyroid hormones or insufficient physiological effects. According to its etiology, it was divided into three types: primary hypothyroidism, secondary hypothyroidism and peripheral hypothyroidism. If the decline in function begins in the fetus or neonatal period, it is called cretinism; the child who begins with sexual development is called juvenile hypothyroidism; the adult begins with adult type hypothyroidism. Female hypothyroidism is more common than in men, and its prevalence increases with age. The incidence of neonatal hypothyroidism is about 1 in 7000. The incidence of hypothyroidism in adolescents is reduced. After adulthood, it is seen to increase. The cause of hypothyroidism is chronic lymphocytic thyroiditis. basic knowledge The proportion of illness: 3% Susceptible people: no specific population Mode of infection: non-infectious Complications: Adrenal crisis, bone hyperplasia
Cause
Cause of hypothyroidism
Hashimoto's thyroiditis (30%):
It is the most common cause of hypothyroidism. The thyroid gland is often enlarged. As the thyroid function area is gradually destroyed, its dysfunction often occurs after many years. Due to abnormal thyroid enzymes, the thyroid is prevented from synthesizing or secreting a sufficient amount of thyroid hormone. Other rare diseases, whether due to hypothalamic secretion of thyroid stimulating hormone releasing hormone (TRH) or pituitary secretion of thyroid stimulating hormone (TSH), do not stimulate the thyroid synthesis or secrete enough thyroid hormone. .
Chronic iodine deficiency in food (40%):
Can cause goiter, hypothyroidism (thyroid hypothyroidism). This is the most common cause of hypothyroidism in many non-developed countries. Since the addition of iodine to salt, the use of iodine-containing disinfectants to sterilize cow's breasts, this type of hypothyroidism has disappeared in the United States. In some rare hereditary diseases, thyroid enzymes are prevented from synthesizing or secreting a sufficient amount of thyroid hormone due to abnormalities in thyroid enzymes. Other rare diseases, whether due to hypothalamic secretion of thyroid stimulating hormone releasing hormone (TRH) or pituitary secretion of thyroid stimulating hormone (TSH), do not stimulate the thyroid synthesis or secrete enough thyroid hormone.
Prevention
Hypothyroidism prevention
(1) Cause prevention of hypothyroidism:
1, the cause of stagnation of small diseases: endemic stagnation, iodine deficiency in pregnant women during the embryonic period is the key to the onset, sporadic stagnation, caused by certain autoimmune thyroid diseases caused by pregnant women, clear cause Prevention, taking anti-thyroid drugs during pregnancy to avoid excessive doses, use small doses of dry thyroid preparations, and avoid other drugs that cause goiter.
2, the prevention of hypothyroidism in adults: timely treatment of thyroid disease that is easy to cause hypothyroidism, prevent hand surgery for thyroid disease or radioactive 131 iodine treatment of hyperthyroidism caused by hyperthyroidism.
(2) Actively prevent the deterioration of the condition of hypothyroidism:
Early diagnosis. Early and timely effective treatment is the key to prevent the deterioration of hypothyroidism. Early treatment with traditional Chinese medicine can effectively prevent the occurrence of complications, and pay attention to the stimulation of life conditioning to avoid aggravating the disease.
(3) Preventing recurrence after hypothyroidism:
After the hypothyroidism, the body is still in the conditioning of yin and yang, taking the stage of "flat". At this time, the diet of the spirit and medicated diet exercises and other comprehensive conditioning. Enhancing physical fitness and improving the ability to prevent disease is an important measure to prevent recurrence after the disease.
Complication
Hypothyroidism complications Complications adrenal crisis bone hyperplasia
Myxedema coma is a complication of life-threatening hypothyroidism, characterized by a long course of hypothyroidism, a coma with very low body temperature (24~32.2 °C), reflex disappearance, seizures, CO 2 retention and respiratory depression Severe hypothermia can be ignored, unless a special low-reading thermometer is used, and a rapid diagnosis must be made based on clinical, medical history, and physical examination because of the possibility of premature death, including cold, disease, infection, trauma, and central inhibitory drugs.
Symptom
Symptoms of hypothyroidism Common symptoms Thyroid stimulating hormone high vulvar dryness constipation Dizziness Renal failure Ataxia Emotions Apathy coma Eye tremor Weight gain
Insufficient thyroid hormone causes the body's physiological activity to slow down. Symptoms and signs of primary hypothyroidism are in sharp contrast to hyperthyroidism, and its onset is concealed and unconsciously. May be misdiagnosed as depression. The patient's facial expression is sluggish, the voice is low, the language is sluggish, the eyelids are drooping, and the face is swollen. Many patients gain weight, constipation, and cold. Hair is sparse, rough, dry; rough, dry, desquamate, and thickened. The patient developed carpal tunnel syndrome; both hands were tingling or stinging (see peripheral neuropathy). The pulse is slow, pale orange (carotene) in the palms and soles of the feet, and the outer part of the eyebrows falls off. Some patients, especially the elderly, may experience confusion, forgetfulness or dementia - their symptoms are easily confused with Alzheimer's disease or other types of dementia.
1, pale, pale face and cheeks, indifferent expression, dementia, dry skin, thickening, rough and more desquamation, non-recessed edema, hair loss, palms and hands are yellow, weight gain, a small number of patients nails Thick and brittle,
2, neuropsychiatric system: memory loss, mental retardation, lethargy, slow response, worry, dizziness, headache, tinnitus, deafness, nystagmus, ataxia, slow reflexes, prolonged Achilles tendon reflexes, severe dementia , stiff, even drowsy,
3, cardiovascular system: bradycardia, decreased cardiac output, low blood pressure, low heart sounds, heart enlargement, can be complicated by coronary heart disease, but generally do not occur angina and heart failure, sometimes accompanied by pericardial effusion and pleural effusion , in severe cases, mucinous edema cardiomyopathy occurs.
4, digestive system: anorexia, abdominal distension, constipation, severe cases may appear paralytic intestinal obstruction, gallbladder contraction weakened and swell, half of patients have gastric acid deficiency, leading to pernicious anemia and iron deficiency anemia,
5, exercise system: muscle weakness, pain, rigidity, may be associated with joint disease such as chronic arthritis,
6, endocrine system: women with menorrhagia, chronic illness, amenorrhea, infertility; male impotence, loss of libido, a small number of patients with lactation, secondary pituitary enlargement,
7, when the condition is serious, due to cold, infection, surgery, anesthesia or improper application of sedatives and other stress can induce myxedema coma, manifested as hypothermia (T <35 ° C), slow breathing, bradycardia, blood pressure drop Muscle relaxation, limbs weakened or disappeared, and even coma, shock, heart and kidney failure,
8, stay a small disease: expression is sluggish, low-pitched pronunciation, pale face, edema around the periorbital, widened eyes, nose collapsed, thick lips flowing, large tongue stretched limbs, duck steps,
9, juvenile type hypothyroidism: short stature, low intelligence, delayed sexual development.
Examine
Examination of hypothyroidism
1, the basal metabolic rate is lower than normal, serum TT4 <40ng / ml, serum TT3 <0.6ng / ml, thyroid 131I rate is low (3 hours <10%, 24 hours <15%),
2, serum TSH value (1) primary hypothyroidism: subclinical hypothyroidism serum TT4, TT3 value can be normal, and serum TSH increased (> 10mu / l), serum TSH level after TRH stimulant test The reaction is higher than normal.
(2) pituitary hypothyroidism: serum TSH levels are low, no response to TRH stimulation test, serum TST levels increased after TSH.
(3) Hypothalamic hypothyroidism: serum TSH levels are low or normal, and respond well to the TRH stimulation test.
3, X-ray: heart enlargement, heart rate slowing, pericardial effusion, skull flat film showing saddle can be increased, ECG shows low voltage, Q-T interval prolonged, ST-T abnormal, echocardiogram shows myocardial increase Thick, pericardial effusion,
4, blood lipids, creatine phosphate, plum activity increased, glucose tolerance curve is flat, anemia.
Diagnosis
Diagnosis and diagnosis of hypothyroidism
diagnosis
First, medical history and symptoms:
The onset is slow, and there are fatigue, fatigue, weight gain, and inability to withstand cold in the early stages. Then sleepiness, slow response, low and thick voice, swollen face, dry skin, hair loss, bloating, constipation, facial yellow, decreased sexual desire, infertility / infertility, menstrual disorders.
Second, physical examination found:
The skin is rough, the system has different degrees of myxedema, obvious lower limbs, anemia, thick tongue, hoarseness, partial goiter, slow heart rate, enlarged heart, severe pericardial effusion, and even pleural and peritoneal effusion.
Third, auxiliary inspection:
(1) Serum TT3, TT4, FT3, FT4, rT3 decreased, and T4 decreased significantly compared with T3. Thyroid-specific antibodies such as TmAb and TGAb increased, TSH increased during primary hypothyroidism, pituitary hypothyroidism or lower Thalamic hypothyroidism TSH does not increase. The TSH and TRH stimulation tests are helpful in the identification of primary, pituitary and hypothalamic hypothyroidism, and blood cholesterol and triglycerides are often increased.
(2) 131 iodine rate decreased in thyroid gland; thyroxine increased in patients with thyroid receptor resistance, but there is still hypothyroidism.
(3) The electrocardiogram shows sinus bradycardia;
(D) X-ray chest X-ray enlargement, some may have pleural effusion.
Differential diagnosis:
Should be differentiated from renal edema, anemia, congestive heart failure and so on. According to rT3 and the patient's primary disease manifestations, with low T3 syndrome, hypothyroidism and galactorrhea should be differentiated from prolactinoma.
